The International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE) define epilepsy as a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures and by the biologic, cognitive, psychological, and social consequences of this condition. This association may reflect the anatomical and neuro-biological source of both epileptic seizures and the behavioral manifestations.

Anti-epileptic drugs (AEDs) can play a role in the genesis of psychiatric symptoms; on the other hand, some psychotropic medications can lower the seizure threshold and provoke epileptic seizures.

Indeed, there is a general agreement that the incidence of neuro-behavioral disorders is higher in patients with epilepsy than in the general population, although some authors argue that this apparent over-representation is due to sampling errors or inadequate control groups. Many, but not all, authors also accept the proposition that the link between neuro-behavioral disorders and temporal lobe or complex partial epilepsy is particularly strong.

Factors in the relationship between epilepsy and behavioral disorders

Mechanisms for a relationship between epilepsy and behavioral disorders include the following:

Multiple interacting biologic and psychosocial factors determine the risk for the development of either schizophrenic form psychoses or major depression in patients with epilepsy, and behavioral disorders in epilepsy have multiple risk factors and multifactorial etiologies.

Psychotic Disorders

Psychotic disorders are severe mental disorders that cause abnormal thinking and perception. Psychotic individuals lose relation with reality. Symptoms generally described as either positive, such as hallucinations, delusions, and disorganized behaviors, or negative, such as diminished range of emotion, reduced speech, and inability to initiate and sustain goal­ directed activities.

Vuilleumier and Jallon found that 2­9% of patients with epilepsy have psychotic disorders. Perez and Trimble reported that about half of epileptic patients with psychosis could be diagnosed with schizophrenia.

The etiology and pathogenesis of psychosis in epilepsy are poorly understood; however, neuro-anatomical changes have been observed in patients with psychosis and include the following:

Psychiatric Disorder

Controls

Patients With Epilepsy

Major depressive disorder

10.7%

17.4%

Anxiety disorder

11.2%

22.8%

Mood/anxiety disorder

19.6%

34.2%

Suicidal Ideation

13.3%

25.0%

Others

20.7%

35.5%

Patients with temporal lobe epilepsy and psychosis of epilepsy have significantly smaller brain volume than people with temporal lobe epilepsy alone, and psychosis of epilepsy is a distinct nosologic entity differing from schizophrenia.All is not lost howeverThe Gbm Foundation launched the Let’s dare2talk about it campaign, principally for the purpose of encouraging the general population to talk about epilepsy and mental health. There is need to talk about our neuro-biological and mental health, and those of our affected loved ones. It is equally imperative to share information and support further research into these highly complex conditions and resulting disorders. The Foundation seeks to contribute to demystify epilepsy, and why not mental illness with which it is closely related.

About Gbm-em

The Gbm Foundation for Epilepsy and Mental Wellbeing maintains this blog to contribute towards the fight against all forms of stigma, rejection and abuses of epileptics and mentally ill from the social and medical systems.
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